34
Hypertension in Patients With Comorbidities
Heart Failure
COR LOE
Recommendations
I SBP:
B-R
In adults at increased risk of HF, the optimal BP in those with
hypertension should be less than 130/80 mm Hg.
DBP:
C-EO
Heart Failure With Reduced Ejection Fraction (HFrEF)
I C-EO Adults with HFrEF and hypertension should be prescribed
GDMT titrated to attain a BP of less than 130/80 mm Hg.
III: No
Benefit
B-R Nondihydropyridine CCBs are NOT recommended in the
treatment of hypertension in adults with HFrEF.
Heart Failure With Preserved Ejection Fraction (HFpEF)
I C-EO In adults with HFpEF who present with symptoms of volume
overload, diuretics should be prescribed to control hypertension.
I C-LD Adults with HFpEF and persistent hypertension aer
management of volume overload should be prescribed ACE
inhibitors or ARBs and beta-blockers titrated to attain SBP
of less than 130 mm Hg.
Chronic Kidney Disease
COR LOE
Recommendations
I SBP:
B-R
SR
Adults with hypertension and CKD should be treated to a BP
goal of less than 130/80 mm Hg.
DBP:
C-EO
IIa B-R In adults with hypertension and CKD (stage 3 or higher or stage
1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g albumin-
to-creatinine ratio or the equivalent in the first morning void]),
treatment with an ACE inhibitor is reasonable to slow kidney
disease progression.
IIb C-EO In adults with hypertension and CKD (stage 3 or higher or stage
1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g albumin-
to-creatinine ratio in the first morning void]), treatment with an
ARB may be reasonable if an ACE inhibitor is not tolerated.
